In helping women recover from c-section surgery I’ve worked on a lot of surgical scar tissue in my practice. It’s amazing how different scar tissue can be from woman to woman. Some scars hardly get thick at all and other’s become as big as ropes.

Emotions Cause thicker Scars

What I have found to be a causative factor in the creation of its thickness is the state of a woman’s emotion during the surgery or accident. The more traumatic an event is the more scar tissue binds up and thickens.

It is possible to help the scar tissue minimize significantly and it can happens rather quickly if you do this one thing. As soon as you release the emotions held in the tissues the scar tissue reduces in size instantaneously. I’d like to share two cases that illustrate my point.

In one case I saw a woman who was several years post c-section. She presented with about a 6-inch vertical incision, which is very rare to see these days. Right around her umbilicus she had a one-inch thickening of her scar that was as big as my thumb. She felt it too before I began working on it.

As I was massaging this area to help mobilize the tissue around this thickened area I was talking to her about the uniqueness of the vertical scar. She expressed how upset she was with the surgeon because there didn’t seem to be any explanation as to why he did it that direction. As I allowed her to have permission for and own her anger toward the surgeon, she was able to process her emotions and the anger inside her released.

The thickened area immediately was 2/3’s less in size than before I started working on it. She was as amazed as I was in the change in size.

In another case this woman had a 9-week-old baby and was having issues with her episiotomy scar. She was having pain and discomfort, a pressure feeling in her perineum. When I evaluated her intra-vaginally there was significant scar tissue on the left hand side of her opening between the vaginal and anal opening. The anal sphincter had thickening on the left side as well. The thickness of this scarring was about the size of a Twizzler rope piece. She was extremely upset about the doctor doing an episiotomy because she really didn’t want one and she doesn’t remember the doctor asking her permission to do one.
As she was able to process through and release the emotions stored in there the scar tissue immediately melted under my touch. She felt so much lighter after releasing the anger and resentment she had around her birth. The perineal area felt more flexible when the scar tissue released. You could barely tell there was any scar tissue left in the area after the session.

These are just two cases that I have helped decrease the size of scar tissue in the body by releasing the emotions tied to them. There are many, many more. It just goes to show that the body does hold onto emotions and they do get stuck in the tissues. The good thing is, it can all be released with proper care.

How to Release Your Surgical Scar Tissue

Yet if your scar tissue is tender and resistant to release, check in to see what emotions come up for you around how the scar got there. You may have been traumatized on some level and that is caught in your scar tissue. Forcing the tissues to release without addressing the emotional aspect can reinforce the trauma already there and cause more pain.

If your surgical scar is really tender and painful, find a professional trained in trauma release therapy to help you release your scar tissue. I find working manually with the tissues and releasing the emotions together gets you a more complete level of healing.

If you haven’t already seen my video on how to massage your C-section scar, check it out here!

Exercise After Childbirth-Part 2

So many women are jumping right back into doing the same exact exercise program they did before getting pregnant and their body is just not ready for it. There are 3 main issues you may experience if you aren’t careful in the post partum period. We’ve already talked about low back pain and why you can develop this problem in a previous post. Click here to review.

Prolapsing of Pelvic Organs

Another issue you can experience if you are not careful is prolapsing of your pelvis organs. Prolapse is when your pelvic organs, your bladder, uterus or rectum, are falling down or out of your vagina. It can feel like pressure in your vaginal area or like a tampon is falling half way out.

I had one client come to see me who was only 7 weeks post partum. She had a stage 3 bladder prolapse. That is where the bladder was sitting at the opening of the vagina. I asked about her delivery and she said it went smoothly, she didn’t push more than an ½ hour and everything felt fine afterwards.

When I asked about what exercises she was doing she reported she was running and doing pilates 100’s. Those are the two worse exercises you can do that early on in the post partum period. She developed her bladder prolapse from the exercises she was doing after having her baby.

What happened to her bladder?

The pelvic floor muscles have been stretched and are weak from childbirth. They run from the pubic bone in front and attach to the tailbone in back. One of the main roles of the pelvic floor muscles is to offer a hammock like support to our pelvic organs, which are also held in place by ligaments. So if your pelvic floor muscles aren’t strong enough to help support your organs, the ligaments have to take on extra work to keep them in place. If excessive strain keeps getting placed on the organs the ligamentous suport can fail, causing prolapse. Whenever we cough, sneeze, laugh or exercise and our abdomen goes forward forcefully, downward pressure gets applied to the bladder and uterus and pushes them down, thus stretching out those supportive ligaments. Any jumping, running, high impact exercises, and/or crunches or pilates 100’s, can create the same downward forces.

When we do these activities without first strengthening our pelvic floor muscles and our abdominal muscles we are at risk of prolapsing our pelvic organs. To learn more about restrengthening your pelvic floor and your abdominal muscles read these articles.

Once your organs fall down it takes a LOT of effort to correct the situation. Most doctors will only recommend surgery; but there are other options. You can work on strengthening your structural support around the organs and see if that can help with the prolapse. This can cover another 5-6 blogposts, but I just want you to know that it is possible to manage this prolapse without surgery.

Stay tuned for the third issue you can develop if you are not careful with exercising after childbirth and then how you can strengthen your body safely!

Pregnancy and childbirth exact an enormous toll on a woman’s body. It is transforming and beautiful, but when a mother does not get the physical and emotional support she needs, the effects can be devastating.

I am a new mother, three times over. Each time after I have given birth, I have benefited enormously from physical therapy afterwards. I could not stand strong, fit, and wholly healed without it.

I am also a physical therapist, myself, and feel that every woman should know her rights to receive physical therapy as a new mother. One of the many fields of specialization in physical therapy is women’s health. I bet you didn’t know that. That’s okay. Most doctors don’t either.

A physical therapist (PT) in women’s health is dedicated to helping women get their bodies back after birth. They can treat a myriad of issues, including pelvic and back pain, incontinence, and other ailments. The American Physical Therapy Association’s 2010-11 report titled Today’s Physical Therapist: A Comprehensive Review of a 21st-Century Health Care Profession, states “physical therapists are committed to facilitating each individual’s achievement of goals for function, health, and wellness.” The core values of a physical therapist are “altruism, accountability, integrity, clinical excellence, social responsibility, and compassion.”

The sad fact, though, is that most new mothers will never get the therapy they desperately need after giving birth.

But I am passionate about turning the tide. All too often, women in general, not just new mothers, do not receive the health care they need. Read my article which reviews the shocking statistics about the crisis in women’s health care today in the US.

A Prime Example of Falling Through the (Medical) Cracks

I have had patients and friends who have suffered from pelvic pain, sexual dysfunction, painful scarring, chronic incontinence, and lower back pain for so long that it has severely altered their quality and enjoyment of life.

A friend recently came to me asking for advice for another girlfriend. Let’s say her name is Teresa. Teresa had just undergone major abdominal surgery (think C-section) and was having awful abdominal pains and even headaches.

Knowing that the two are related, based on her surgery type and plan of care, I immediately asked if the surgeon had referred her to physical therapy. Of course the answer was no. Her plan of care did not include any post-operative physical therapy. In fact, when I asked Teresa directly, she said her doctor (a woman, mind you) had never even mentioned needing physical therapy.

I was upset by what I felt was an oversight by the physician to refer Teresa to therapy, but mostly I felt a surge of urgency to help her. This woman needed therapy immediately, yesterday, even. She was floundering, depressed, in pain, and alone at home six weeks after major surgery on her reproductive organs due to a cancer scare. She had no idea how to get better (she had been a marathoner) now that she had this huge scar (larger than that of a C-section) across her abdomen. Even coughing caused pain, and the related headaches and back pain were terrifying.

But, it was not the doctor’s fault. Not really.

Doctors are educated very little, if at all, about PT services in medical school. A good friend with an MD sister said this when asked if she had learned about PT in medical school: “sure, we had education about what PT’s do in medical school. It was a single lecture, on one day, it was optional, and it covered all allied health care services.”

Physical therapists spend a similar amount of time in earning their degree in physical therapy (7-8 years) as doctors do in medical training. There really is no way a single optional lecture in medical school can prepare physicians to know what PT’s do and how to refer for physical therapy.

The Take Home Message

Be your own advocate in health care. Before going into surgery or giving birth, educate yourself about what to expect and what you will need for your body to heal fully.

The biggest mistake a mother can make in seeking maternity care is assuming her doctor knows best. The doctor may not even know PT’s treat women’s health issues, much less how to refer to PT for prenatal or postpartum rehabilitation.

There is good news though. Here are the tools you need to get physical therapy after giving birth:

First, BEFORE you give birth, ask your doctor is he/she refers to physical therapy after giving birth. If you already have low back or pelvic pain during pregnancy, then you should get a referral for physical therapy now. Do not wait until after giving birth.

Ms. Garner is an educator, integrative physical therapist, and founder of Professional Yoga Therapy Studies, an organization that creates inter-disciplinary curricula and educational competencies for using yoga in medicine and rehabilitation. Ms. Garner received her Master of Physical Therapy from the University of North Carolina at Chapel Hill, where she completed studies in the School of Medicine and School of Public Health. Ms. Garner began working in the field of integrative therapies in 1995, after becoming licensed in sports medicine. Her clinical specialties include public health education, orthopaedics, and pain management, with a focus on maternal health.

Ms. Garner has been writing, teaching, and lecturing for hospitals and medical practices throughout the US since 2000, and in 2012 she joined the Caring Economics Coalition and the work of Dr. Riane Eisler, who she credits as one of her greatest mentors. Ms. Garner now consults pro bono with medical schools at several domestic and international universities in order to develop integrative medicine curriculum in medical therapeutic yoga. She is currently an instructor with Medbridge Education and consultant at the University of Mississippi Medical Center, Misericordia University’s Doctoral Physical Therapy program, and the University of Saskatchawan School of Medicine. These evidence-based programs are a first of their kind in North America.

Ms. Garner considers her most important work to be in maternal health care advocacy and health care policy, where through her multi-media platforms she works to increase awareness of, and eliminate barriers to, receiving holistic and integrative health care. Ginger is a mother of three children, and lives with her husband and rowdy sons on a small island off the east coast of the US. Ginger can be contacted at www.gingergarner.com and www.professionalyogatherapy.org.

If you were to ask any woman what is the number one exercise to do for a healthy pelvis and the answer would be “a kegel,” or pelvic floor contraction. Healthcare Practitioners all tell you to do a Kegel if you are peeing in your pants when you laugh, cough, jump or sneeze or if your bladder is falling out. It’s the number one “go to” exercise that women are told to do with any problem in the pelvis. Contrary to popular belief the Kegel may not be all that it’s cracked up to be and is not always what I recommend.

The Problem with Kegel Exercises

We are well aware of the state of the muscles we see on the outside of our body. You can look at your biceps, your “Popeye” arm muscle that helps bend your arm, and see if it’s got good tone in it or not. A muscle used through normal daily activity stays rather healthy and strong. If you were to immobilize a joint the muscles influencing that joint quickly fade away to mush.

The problem with our pelvic floor muscles is we can’t see them and probably have no idea what state they are in. Are they truly weak or do they have too much tone in them? Just like the knots in your shoulders cause your shoulders to raise up to our ears, the pelvic floor muscles can have too much tone in them causing them to contract and not be able to relax. So many women are walking around with TOO MUCH tone in their pelvic floor muscles and yet the number one suggestions practitioners make with any problem in the pelvic floor area is “DO KEGELS!” If the muscles don’t know how to relax and have too much tone in them, doing Kegels is only going to make the problem worse.

Think of the pelvic floor muscles as an elevator. Normal resting tension is at the ground floor. A full contraction starts at ground floor and reaches 5th floor, maximum contraction ability. If you are holding tension in your pelvic floor muscles and they hang out at 3rd or 4th floor all the time there is not much contractile ability for the muscles to get you to 5th floor. The contraction feels very weak and doesn’t move very far. It’s not that the muscle is weak per se, it’s that it’s already contracted and can’t find the ground floor. It’s really relaxation ability that is needed for these muscles. They need to find ground floor again. Doing more kegels is like banging your head against the wall! You are not going to get very far.

The other problem with Kegel’s is not many women know how to do them correctly. They just don’t know how to engage the muscles to get them to contract. To read more about the correct way to kegel click here. In my practice it’s very common for women to NOT be able to fully contract their pelvic floor muscles. We carry so much tension in our pelvic floor muscles that they can’t fully relax all the way to be able to contract fully.

What about after childbirth?

The pelvic floor muscles get stretched to their max, are lengthened after having a baby and need help finding the ground floor again. So you think that strengthening for most moms after childbirth is critical. Well it is in most, but not all moms.

It is interesting to note that in some women, just months after having a baby when you’d expect to find lengthened weakness in their pelvic floor that they are actually hanging out at 4th floor. This may be due to trauma in the muscles or an unconscious holding pattern. If you tear during childbirth then scar tissue can cause increased tone in the muscles and help hold the muscles at 3rd or 4th floor. Getting those muscles to relax is key.

So how do you know what state your pelvic floor is in?

You’ve got to check yourself! Yes that means inserting your finger inside your vagina and feeling your muscles engage and relax. How do you do this?

Checking for Pelvic Floor Strength:

Sit semi-reclined so back is nice and supported

Bend knees up and separated slightly

Insert your index finger or thumb into your vaginal opening

Think of the opening as a clock and check your muscle contraction ability in 4 quadrants: at 1:00, 5:00, 7:00 and 11:00.

See if the left side contracts the same at the right side: 1:00 and 11:00 should be the same as is 5 and 7:00.

Checking out the relaxation ability of the muscles is just as important as the contraction ability.

Addressing tone in the pelvic floor muscles

Gentle massage of the tissues may help it respond more and be able to contract more fully. If you are postpartum your pelvic bones may be out of place and may need some adjustments to get back to normal positioning after childbirth.

Also learning how to relax the pelvic floor muscles is key. Feel the tension in your muscles when you check internally. Both sides should be able to bounce and move up and down with pressure. If one side moves and the other doesn’t then you need to work on the side that doesn’t move. Adding gentle pressure and encouraging the tissues to relax is key. Focusing in on that muscle and breathing into it can help it relax.

See a Women’s Health Physical Therapist if you need help in discerning what your pelvic floor muscles are doing or need help in getting them to relax.

While it is important to have good contraction ability of your pelvic floor I believe there is a much better way to keep your pelvis healthy and strong that doesn’t involve Kegelling! Stay tuned as I’ll share with you what that is all about. Until then check out your pelvic floor muscles and see what shape yours are in.

Check out other great blog posts:

Sarah Cody at birth play love gives a run down of the importance of eating organics:

10 Tips for a Healthy Bladder

Do you ever remember learning anything about your bladder and how it works? Do you know how a normal, healthy bladder works? Here are 10 tips to help you have a healthy, strong bladder.

What color is your urine? Ideally a light, pale yellow to clear color is the goal. Any darker color means your urine is more concentrated and can irritate the bladder making you have to urinate more frequently. You need to be drinking more water. It is recommended that you drink half of your body weight in ounces. A 150 pound person should be consuming 75 ounces of water a day.

Are you urinating more than 6-8 times a day? The average bladder holds about 2 cups of urine before it needs to be emptied. Normally you should urinate every 2-3 hours. As we get older, our bladder capacity can get smaller and we may need to pass urine more frequently but usually not more than every 2 hours.

Take your time when you empty your bladder. Don’t push or strain to force out the urine. Urine should flow easily without discomfort in a good, steady stream until the bladder is empty. Make sure you empty your bladder completely each time you pass urine. Do not rush the process.

Avoid going to the toilet “just in case” or more often than every 2 hours. It is usually not necessary to go when you feel the first urge. Try to go only when your bladder is full. Urgency and frequency of urination can be improved by retraining the bladder and in some cases with manual therapy by an experienced physical therapist. Also spacing your fluid intake throughout the day can help. Don’t let your bladder control your life.

Don’t wait too long to urinate either. Waiting more than 4 hours between toileting or urinating too infrequently may be convenient but not healthy for your bladder.

Limit the amount of caffeine (coffee, cola, chocolate or tea) and citrus foods you consume as these foods can be associated with increased sensation of having to urinate.

Limit the amount of alcohol you drink. Alcohol increases urine production and also makes it difficult for the brain to coordinate bladder control.

Avoid constipation by maintaining a balanced diet of dietary fiber.

Perform regular exercises of the pelvic floor to keep normal bladder control. Most people think of Kegels as the answer to all issues in the pelvis but actually having strong gluteal (think butt) muscles is just as important. The best way to strengthen your pelvic floor is in a squatting position, keeping your butt sticking out back and not curved under, and THEN perform a Kegel or pelvic floor contraction.

Keep your lower abdominal muscles strong too. Your transverse abdominal muscles along with the pelvic floor muscles help to support your bladder. Learning how to use these muscles together in various activities is very helpful in keeping your bladder in its proper place.